| NPI | 1558562850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 42897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101241715) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TN 42897) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2026-02-19 |